Employment Application - The Meadows of Rutland, VT

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The Meadows is an equal opportunity employer and does not discriminate against applicants or employees on the basis of sex, race, color, religion, sexual orientation, national origin, ancestry or age. In addition, The Meadows does not discriminate against qualified individuals with disabilities.

For your convenience, you may upload a resume and optional cover letter below. To be considered for employment, we encourage you to read through our application and fill in those areas not directly addressed in your resume, including specifying the job you are applying for, availability, background check information, and your signature at the conclusion of the application.

Resume

Accepted file types: pdf, doc, docx, Max. file size: 32 MB.

Upload a PDF or Word Document up to 10MB.

Cover Letter

Accepted file types: pdf, doc, docx, Max. file size: 32 MB.

Upload a PDF or Word Document up to 10MB.

Personal

Name

First Last

Address

Street Address Address Line 2 City State ZIP Code

Home Phone

Cell Phone

Other Phone

Last 4 Digits of SSN#

Date of Birth

Month

Day

Year

Place of Birth

City, State

Position Applied For:

Full Time

Part TIme

Shift Availability

Days

Evenings

Nights

Date available to start:

MM slash DD slash YYYY

Are you over 16 years of age?

Yes

Have you ever been convicted of a misdemeanor or a felony?

Yes

If yes, please explain:

Have you applied to work with us before?

Yes

If yes, when?

Are you willing to work overtime, on different shifts, or on weekends when necessary?

Yes

If no, please explain:

Do you have access to adequate transportation to travel to and from work in all weather conditions?

Yes

The Meadows has a strict attendance policy. Will you be able to abide by a strict attendance policy?

Yes

Education

High School Name

Address

Street Address Address Line 2 City State ZIP Code

Number of years completed:

Did you graduate?

Yes

Other

College Name

Number of years completed

Did you graduate?

Yes

Other

Major

Other Education (Please Specify)

Employment History

Most recent employment first

Employer #1

Address

Street Address Address Line 2 City State ZIP Code

Start Date

MM slash DD slash YYYY

End Date

MM slash DD slash YYYY

Supervisor

Position Held

Your Duties

Reason for Leaving

Employer #2

Address

Street Address Address Line 2 City State ZIP Code

Start Date

MM slash DD slash YYYY

End Date

MM slash DD slash YYYY

Supervisor

Position Held

Your Duties

Reason for Leaving

Employer #3

Address

Street Address Address Line 2 City State ZIP Code

Start Date

MM slash DD slash YYYY

End Date

MM slash DD slash YYYY

Supervisor

Position Held

Your Duties

Reason for Leaving

Have you been employed at any of the local hospitals, nursing facilities and/or residential care homes?

Yes

If yes, where?

References

Professional Reference #1 (supervisor, co-worker, teacher, etc.)

First Last

Relationship

Phone

Professional Reference #2 (supervisor, co-worker, teacher, etc.)

First Last

Relationship

Phone

Personal Reference

First Last

Relationship

Phone

US Military Service

Branch

Highest Rank Received

Dates of Service

Duties

In Case of Emergency

Please notify:

Name

First Last

Address

Street Address Address Line 2 City State ZIP Code

Phone

Relationship

Name

First Last

Address

Street Address Address Line 2 City State ZIP Code

Phone

Relationship

Other Experiences or Qualifications

Who referred you to The Meadows?

Newspaper advertising

Indeed

Craigslist

Family member or friend

Internet search led you to The Meadows website

Employment agency

State employment office

College placement service

Walk in

Other

Certification and Authorization

(please read)

I certify that all facts contained in this application are true and complete, and acknowledge that The Meadows is relying on the accuracy of the information provided. I authorize The Meadows to verify the accuracy of the information provided herein, and I authorize former employers, educational institutions and credit agencies to release information concerning me to The Meadows. I also authorize The Meadows to give references and provide information about me in response to inquiries subsequent to my employment if hired. I understand that falsification, misrepresentation or omission of requested facts may result in the denial of employment or, if employed, result in immediate dismissal. I understand that, if hired, my employment is “at-will.” I also understand and agree that no one has the authority to promise me job security or continued employment except the CEO of the company in a formal written agreement signed by both of us. In addition, I am giving The Meadows at East Mountain my permission to run a detailed background check on me, including but not limited to: adult abuse, child abuse, fraud and criminal. I recognize that this consent does not constitute an offer of employment, but is a preliminary step in the screening process. An offer of employment is contingent upon no findings in the adult abuse and child abuse checks; I understand the said offer will be revoked due to VT State regulations governing residential care communities. I further understand that I have the right to review and challenge any negative information that would adversely impact a decision to offer employment. Also, I will have a reasonable opportunity to clear up any mistaken information reported within a reasonable time frame established within the sole discretion of the company. Under the Fair Credit Reporting Act, I have been advised that upon request I will be provided the name, address, and telephone number of the reporting agency, as well as the nature, substance and source of all information.

Please check the box below to acknowledge acceptance:

I understand I may lose my job if any background check comes back with a finding.

Signature

Please note: If you are called for an interview, please bring your driver’s license with you.

Comments

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